68 year old female with CVA

 A 68 yr old female came to casuality with C/O 

1. Tingling and numbness in right lower limb and right upper limb since 3 pm yesterday

2. Slurring of speech since 3 pm yesterday

3. Weakness in right lower limb since 3 pm yesterday


HOPI:

Patient was apparently asymptomatic 1 day ago 

Then she developed tingling and numbness in right lower limb and right upper limb,slurring of speech and weakness in right lower limb since 3 pm yesterday


No H/O headache, vomiting, dysphagia.

No h/o  regurgitation, involuntary micturition and defecation

No other complaints


PAST HISTORY:

Not a K/C/O HTN/DM/TB/Epilepsy/CVD/CAD


PERSONAL HISTORY:

Diet - mixed

Appetite - normal

Sleep - adequate

Bowel movements - regular

Micturition - normal

No known allergies


Patient has a habit of chewing betel leaf(zarda) since 50 years


FAMILY HISTORY: Not significant


GENERAL EXAMINATION:


Pt is C/C/C

Vitals:

Temp - Afebrile

BP-100/70 mmHg

Pr-78 bpm

RR-22 cpm

SpO2- 98% at RA

GRBS- 117 mg/dL




SYSTEMIC EXAMINATION:

Cvs- S1,S2 heard

CNS- Oriented to T/P/P

Memory intact              RIGHT.                      LEFT 

  • Power U/L       4/5.                                  4/5 
  •              L/L      4/5                                   4/5 
  • TONE U/L.        N.                                   N   
  •              L/L.    slight hypertonic               N

 Reflexes     Upper limb             Lower limb 

Biceps              +                                  +

Triceps              +                                 +

Supinator           +                                +

Knee                  +                                 +  

Ankle                 -                                   -

Plantar                E                                P

P/A- Soft, non-tender

RS-BAE+ , NVBS+

INVESTIGATIONS 

CBP


2D ECHO


HAEMOGRAM,LFT,RFT

ECG
USG




PROVISIONAL DIAGNOSIS:

CVA with Hemiparesis with Acute Infarct in the posterior limb of left internal capsule


TREATMENT:

1. Tab. ECOSPIRIN-AV 150/20 mg PO/ H/S

2. Tab. CLOPITAB 75 mg PO/OD

3. Tab. PAN 40 mg PO/OD

4.Tab.OPTINUERON 1 amp in 100 ml NS IV/OD 

5.Physiotherapy

6.TAB RENERVE -P H/S 

Ward


S-Tingling of right lower limb decreased 


O-Patient is c/c/c

Temp -afebrile

PR-65bpm

BP-

Cvs-S,S2 present 

CNS-oriented to T/P/P

Speech -normal 

Power-

            Rt. Lt 

UL- 4/5. 4/5

LL- 4/5. 4/5


Tone- 


UL- Normal. Normal 

LL- slight hypertonic N


Reflexes-

B. +. +

T. +. +

S. - -

K. +. +

A. - -

P. E. P


A

Rt hemiparasis with Rt CVA secondary to acute infract in the left internal capsule


P

1. Inj.Optineuron 1amp in 100 ml NS IV/OD

2. Tab.Ecospirin-AV (150/20)PO/Hs

3. Tab.Clopitab 75mg PO/OD

4. Tab.Pantop 40mg PO/OD

5. Physiotherapy rt lower limb

6. Tab.Renerve PO/HS

Comments

Post a Comment

Popular posts from this blog

30 year old RENAL TRANSPLANT RECIPIENT with deranged RFT

Image
 Chief complaints  Renal transplant recipient came with deranged RFT values on routine investigation done for his renal transplant came to kamineni on 7/2/22 No c/o pedal odema  No c/o SOB ,facial puffiness  HOPI  Patient was apparently asymptomatic then on routine investigation done for renal transplantation revealed elevated creat levels  Sr creat - 3.5mg/dl  Urea - 85 mg/dl  No h/o decreased urine output ,urinary retention Past history  H/o previous admissions for dialysis for 2 years (CRF)  K/c/o HTN on tab amlong 10 mg - 5 mg - 10 mg  Tab.arkamime 0.2 mg po/tid  H/o 2 times intubation and extubation i/v/o pulmonary oedema , hypertensive emergency and resistant hypertension 2 years back  H/o loculated pleural effusion and icd drainage 2 years back  Treatment history  K/c/o htn on tab amlong and arkamine  Surgical history  K/c/o renal transplant recipient  Personal history  Single  Appetite - normal  Bowel and bladder movement - normal  No known addictions  Family history - not sign
Read more

50 yr old farmer with decreased urine output

Image
Chief complaints  C/o SOB since 1 week  C/o swelling in the legs  C/o decreased urine output  HOPI A 50 yr old Farmer doing his regular work, of driving tractor till one week ago when he had sob with sweating, taken to a doctor outside ,where his grbs was recorded low ,was revived with eating a chocolate only, but he continued to take his oha even after that,rft showed increased creatinine,since 3 days his symptoms aggrevated and was brought here for further management ,2 sessions of dialysis  1 st -19/2/22 from 10 am to 2 pm , 2 nd - 20/2/22 were done   PAST HISTORY  known case of DM since 3 years on medication  HTN since 6 months (giddiness first symptom ) NO H/o asthma ;TB;EPILEPSY PERSONAL HISTORY  Marital status - married  Occupation - Farmer  Appetite - Normal  Diet - Decreased appetite  Bowel and bladder movements - regular Addictions -  Chronic alcoholic since 20 years daily 180 ml. Chronic smoker since 20 years  daily 2-4 beedis per day. No significant family
Read more

44 year old with ALD

Image
  CHIEF COMPLAINTS   44 year old male came to casualty with chief complaints of fever with chills on and off high grade associated with chills and rigor  HOPI  patient was apparently asymptomatic 12 years back had history of intake of alcohol initially 90 ml   gradually progress to amount of 200 ml  since 2 years patient was on alcohol 200 ml , quantity increased to daily intake  of with no  or minimal food intake H/O agressive behaviour  tremors +  decreased appetite  yellowish discoloration of sclera present  vomiting of 1 episode , patient was admitted in outside hospital and treated as alcoholic liver disease With TB - 23.7 gradually reduced to 2.5   pain abdomen +  passing stools (1-2 ) episodes/day  No loose stools , vomitings,malena ,blood in stools  Past history  N/K/C/O - DM, ASTHMA,TB , EPILEPSY Personal history  married  appetite - lost  bowel - regular  micturition - normal  known alcoholic since 12 years  GENERAL EXAMINATION  no pallor,icterus,cyano
Read more